Safety and Infection Control: Precautions, Restraints, and Never Events
What you must understand
This domain rewards precise recall of transmission-based precautions. Standard precautions apply to all clients: hand hygiene, gloves for contact with blood or body fluids, and eye/mask protection when splash is likely. Contact precautions (MRSA, C. difficile, scabies, RSV in infants) require gown and gloves and dedicated equipment; C. difficile also requires soap-and-water handwashing because alcohol does not kill spores. Droplet precautions (influenza, pertussis, meningococcal meningitis, mumps) require a surgical mask within about 3 feet and a private room or cohorting. Airborne precautions (tuberculosis, measles, varicella, disseminated shingles) require an N95 respirator and a negative-pressure room.
Also know fall-risk interventions, restraint alternatives and the requirement for provider orders, timed monitoring, and release, safe medication administration (three checks, two identifiers), and never events such as wrong-site surgery and retained foreign objects.
Traps to watch
- Mask type. Surgical mask for droplet, N95 for airborne. A question offering an N95 for influenza is a distractor.
- Shingles. Localized herpes zoster needs contact precautions; disseminated zoster needs airborne.
- Restraints are last resort. Try least restrictive measures first, and never tie to side rails.
- Hand hygiene timing. Before and after gloves, and after touching contaminated items even if gloves were worn.
Rule of thumb
Name the organism, name the route of transmission, then pick the precaution. If you cannot name the route, standard precautions plus a private room is the safe default.
Worked example
A client with active pulmonary tuberculosis is admitted. Place in an airborne infection isolation room with negative pressure, wear an N95 respirator on entry, keep the door closed, and transport only when necessary with the client wearing a surgical mask.